VASCULAR COMPLICATIONS RELATED TO INTRAAORTIC BALLOON COUNTERPULSATION - AN ANALYSIS OF 10 YEARS EXPERIENCE

We have performed a retrospective review of our experience with the in traaortic balloon counterpulsation pump (IABP) during the last decade, to identify aspects of risk factors, complications, and management th at affect peripheral vascular morbidity and mortality. Data from 472 p atients who had the IABP inserted during the ten-year period from Dece mber 1985 to December 1995 were retrospectively reviewed. Risk factors , implantation techniques, complications, and significant variables we re evaluated. One hundred forty-five vascular complications needed sur gical therapy in 116 patients. Mean age was 62.2 +/- 12.9 years. There were 84 (72.5%) men and 32 (27.5%) women. Mortality rate was 28.3% (n =181). The mortality for patients with ischemic vascular complications was significantly higher than in patients who did not suffer any vasc ular complication (59.6% vs 30.1%, p=0.0001). Complications included a cute limb arterial occlusion in 99 cases (68.3%), compartment syndrome in 27 (18.6%), groin hematoma in 15 (10.3%), and persistent lymph fis tula in 4 (2.8%). Of these, 97 (76.9%) occurred during IABP therapy an d 29 (23.1%) after IABP explantation. Thromboembolectomy was required for 61 (42.2%) of the ischemic limbs. Associated procedures were 24 (1 6.5%) profundaplasties, 10 (7%) infrainguinal bypasses (5 (3.4.%) femo ropopliteal supragenicular, 3 (2.2%) femoropopliteal infragenicular, a nd 2 (1.4%) infrapopliteal), 26 (17.9%) fasciotomies, and 5 (3.4%) amp utations. A history of peripheral vascular disease (31 patients [43.6% ] with vs 95 [23.6%] without, p<0.05) and the presence of diabetes mel litus (70 patients [49.2%] with vs 56 [16.9%] without) increased the r isk of limb ischemia significantly. Female sex, insertion of IABP by p ercutaneous technique, and direct removal with groin compression were associated with higher ischemic complication rates, the differences ho wever were not significant. Itis concluded that 1. Limb ischemia remai ns the primary complication after IABP insertion; 2. Femoral artery th romboembolectomy is usually sufficient for revascularisation; 3. Adequ ate implantation and surgical explantation techniques are essential to reduce the IABP-related morbidity; 4. Identification of subclinical d isease may aid in the management of subsequent acute limb ischemia; 5. The presence of peripheral vascular disease and diabetes mellitus are associated with higher ischemic complication rates.